Lori Walsh: The scientific method is by definition, nonpartisan and unbiased, and yet in an America where political division threatens to be the rule, not the exception, politicized science can cloud how a nation responds to a pandemic, and that can erode trust and put lives at risk.
Dr. Wendell Hoffman is an infectious disease specialist and clinical professor of medicine at the University of South Dakota Sanford school of Medicine. I should say, he's an infectious disease specialist at Sanford Health. He writes about the destructive bias of politicized science in South Dakota medicine, and he joins us now on the phone. Dr. Hoffman, welcome back. Thank you for being here.
Dr. Wendell Hoffman: Thanks very much, Lori, for having me
Lori Walsh: Well, this article has given me so much to think about, so thank you, first of all, for sharing it with us. I'm looking forward to this conversation. Tell me a little bit about why you wanted to write for a South Dakota and beyond audience about politicized science. Where did this idea sort of percolate for you?
Dr. Wendell Hoffman: Yeah, so thanks for the opportunity. I mean, it's always risky business to try to speak about political bias from the middle, but I really attempted to use what I would call sort of inductive reasoning, where I pose seven questions to characterize the general. So the specific to characterize the general. The general I'm calling destructive bias. But the reason that this was prompted is that we were just encouraged by SDSMA and South Dakota medicine in general, to offer perspectives on COVID-19. This very early on became very clear that so much of this pandemic is being colored, indeed being infiltrated, if not infected by a political bias. So that was the background. And it's trying to, and again, I try not to be categorical or necessarily absolutely certain, but I try to lead to the probable and there's a lot out there to comment on. So that's the background for it.
Lori Walsh: Yeah. Dr. Shankar Kurra said in our interview this morning. I asked him a question. He said, "Some of this is science by press." And I had to chuckle, because the point here is that so many people are paying attention. Journalists are paying attention. Every day South Dakotans are paying attention too. We hear the governor, saying again and again, we're relying on science and data, and everybody's talking about science and data. But when you look on Facebook, boy, people have a different idea of what science and data is. M.
My question for you regarding all of that is what about this moment? Is it just because it's a pandemic and all of our lives were at stake or was there something else happening that made this moment be as politically charged as it was, and that the spotlight would shine so brightly on it and without ceasing?
Dr. Wendell Hoffman: Right. Great, great question. So, yeah, we've got two simultaneous events going on, one which demands that we come together, the other one which is pulling us apart. In a normal political season, we'd be having aggressive debates. And it's not that we're not permitted to have our own biases, or our support. It's just that this time around, and I frankly have never seen it like this in 40 plus years in medicine, where we're so quick to blame, which is very troublesome to me. In medicine, you know, if an adverse event happens, one of the things we've learned over time, and this is part of the patient safety movement, is it when something bad happens that you don't want to happen the first impulse is not to blame, but to learn. But what we're seeing in the current foray back and forth is the rush to blame. And so on the one hand you have our president calling this the China virus. On the other hand, you have our Speaker of the House calling it the Trump virus. I don't think neither are helpful at all.
Yes, the virus did come from China, by all evidence from the Wuhan province. But we have not necessarily identified origins for all prior, either epidemics or pandemics. I mean, the last pandemic, which was an influenza pandemic started in Mexico. Well, we don't call it the Mexican pandemic, but we do cite areas of origin, like let's say, West Nile. That tells us about a geographic origin. How about Ebola? That cites a geographic origin. But in both those cases, in those two cases, the reason to use the term is not to blame. It's to learn.
So that in my opinion is one of the big challenges that we have as a nation. How can we from the middle say, "Wait. From both ends stop the destructive bias because it's preventing us from coming together." We need more than ever to focus on the team aspects that really will help mitigate the spread of this virus, and help our fellow citizens, and everyone across the board. So I think that's the major issue, is that these two simultaneous events, one of which must bring us together, the one is pulling us apart like nothing I've ever seen,
Lori Walsh: Right. You talk in this article about the seven deadly sins of destructive bias. Let's look at some of these specific things, because I felt even as I was reading it they're very useful, even as you know how we do journalism. This is talking about the scientific method, but when you look at something and you try to be unbiased or nonpartisan, you try to root out what exactly is it and where does it lie? So tell me one of these seven deadly sins and kind of give me an example. We've already started this, but a pick another one for me, Dr. Hoffman.
Dr. Wendell Hoffman: So I think maybe I can frame that up a little bit by saying that, and I refer to this in the essay too, is that physicians we're grappling, healthcare systems are too, with how to proceed because we're confronting what I'm calling three flashpoints that demand our obligation. The first is the demand to help while not doing harm in the individual COVID patient. The second is the demand to protect public health while delaying care on the non-COVID-19 population. And the third is the demand for reform in American medicine while health disparities further emerge. For instance, when you see the part of our population that is really getting hammered, if you will, it's the Black American population that is suffering tremendously and almost disproportionately.
And so you can imagine going forward, you don't have to imagine at all, I think it's a reality that there will be a demand for reform in American medicine. But that's nothing new. There's been a demand for reform, and we even see it internally. So to get to the point, and one example I would use as an example here is the individual decision-making for patients that have this infection, and what do we do when, quote unquote, there is no proven therapy? Now we're in a much better place now than we have been. But I'll use for an example, the hydroxychloroquine debate, which I think has been very, I hate to say fascinating, but kind of fascinating in a sense. And so I pose in the essay, I say, "Is hydroxychloroquine by prescription in the thousands over months more harmful than Plaquinel by prescription in the millions over decades?
And I simply call this character assassination. For clearly, no matter what the ultimate evidence regarding hydroxychloroquine is in COVID-19, Plaquinel... In other words, Plaquinel is not Dr. Jekyll, nor is hydroxychloroquine Mr. Hyde. They're both the same thing. Plaquinel is the trade name. Hydroxychloroquine is the generic name. The controversy has really over the use of hydroxychloroquine in patients primarily who have become ill, are in the hospital and have become very ill. And so the studies, and there are a number of controlled trials, randomized control trials, which demonstrate that it has shown no benefit. However, there's been a lot of pushback on these RCTs, that maybe they weren't as well done, well designed as they should have been. But you don't really hear that much in the news media. On the other hand, you have this controversy that perhaps hydroxychloroquine plus other antibiotics, such as azithromycin or doxycycline plus zinc may have a role to play early in the course of the virus.
Why is that? Because COVID-19 is kind of a bi-phasic illness. The first phase kind of more like almost a cold. The second phase, more like a pneumonia. The first phase is the what we call the viral phase, the viral replication phase. The second phase is more of an immunologic phase where we have the gearing up of this aggressive immune response that pours fluid and foments blood clots in the lung that take the patient down from a respiratory standpoint. So it wouldn't be surprising that an antibiotic or an antimicrobial, I will say, wouldn't be of much help if you gave it late. And that's what we see in sepsis. When somebody turns the corner and goes down the tube with septic shock, let's say, wouldn't you rather have the antibiotic given as early as possible? And the answer is of course.
And so the outlying question still is, "Does this drug in combination with perhaps other agents, is there still a role?" The problem is it's very difficult for physicians even to consider prescribing it because its character has been drawn into question, and very few people want to go there. It's very difficult, even in this country now, to do hydroxychloroquine studies, because it would be difficult to recruit patients, A. And B, it would be difficult to get funding. So that's an example.
I'm rooting for anything that helps patient, right? And if there is a role for this early on, I think that would be wonderful. I mean, think about it. It's an off-the-shelf drug that's very inexpensive, which was why we were all excited about it early on. Yet when the data started to come in, these trials started to come in, we didn't see the kind of benefit we were hoping for.
However, the drug was by and large used late in hospitalized patients, which is why my own society, Infectious Disease Society of America, recommended against its use. But it was recommended against its use in hospitalized patients. So I think there is a genuine, honest question that we need to continually face, but I think the politicization of this has made it difficult. It's one more thing that's driving us away from a drug, and part of it's because president Trump endorsed hydroxychloroquine. I think that definitely had an effect. Suddenly people line up and they go into their corners and they say, "Well, if so-and-so says such-and-such," it makes it less likely that we're going to go and use that kind of a therapy. So that's one of the kind of seven deadly sins as I try to call it. And, of course, the political parties do this all the time anyway, right, they try to degrade each other which is not healthy.
Lori Walsh: Right. And I think that's worth noting is that some of this is intentional. As we move into an election that both parties and individuals are going to be intentionally trying to politicize science for their benefit. The tune might change post-election depending on who wins, and we need to have an awareness about that. But let's talk a little bit about how, because we as in the nonmedical public, want the medical journals and physicians like you to be completely nonpartisan and maybe even rely on that non-partisanship. But you've been seeing evidence even in medical journals or with some leadership from some of these organizations that is revealing a bias as well. Tell me a little bit about that.
Dr. Wendell Hoffman: Well, so I say that these examples of destructive bias, and again destructive bias is anything which prevents us from coming together as I'm defining it. These have been longterm weapons used, right? But when very outstanding premiere journals show some evidence of political preference, and I cite two examples, Lancet and Nature, as examples. So the first one, Lancet's decision to publish a major study that diminished the role of hydroxychloroquine, and also contributed to international changes in recommendation, had to be pulled very quickly because the source of their data was highly questionable. So they had to pull it. And so the question was, and this was raised by a writer in the Wall Street Journal, that said that, "Lancet's decision to publish a study with little apparent scrutiny suggests that politics may be influencing good, scientific judgment."
And I just said, "They're removing all doubt." Lancet had just earlier stated in it's editorial page that Americans must put a president in the White House in January 2021 who will understand that public health not be guided by partisan politics. And I just simply almost cynically said, "How nonpartisan of Lancet not to be guided by partisan politics." And so that concerns me. Now do I think that it's widespread that journals are politicizing, they're allowing their editorial page to politicize their research page? Absolutely not, but even one episode. I mean, it wasn't that Lancet or Nature, which was the second episode, who actually said just prior to the 2016 that, "Clinton must take the reins." And then a year later, they waited again and they said, "After 12 months in office Trump's impact on science can be neatly divided into two categories, bad things that people expected and bad things that they didn't." And then I just, again, a little cynically say, sarcastically say, "How scientific of Nature to be so neatly categorical."
And so I put forward the question to both editorial boards. By what authority do you speak so confidently to the political realm when per the literature of medi-science, so much of what we publish is not entirely true? And so I'm just trying to, and again I think both of these journals are outstanding. They're premiere, which is why it was kind of disappointing. And I just point out that any organization who serves a diverse population of readers must be very careful. It's fine if scientific journals have an issue-oriented criticism or praise, I think that's all fair game. But in this case, they rendered an opinion as to who should not be the American president, and I don't think this should happen ever.
I say, imagine if the healthcare system were to weigh in on who should or should not be the American president. I mean, heads would roll. Even on one occasion if we... And of course people say, well, we're a 501(c)(3). I agree. But isn't there even a higher reason than your tax status not to be doing this? And so I just think, and I point these examples out, that it concerns me that the politics, like I said the Coronaficaton of medicine has now become a subset of the politicization of everything. So I don't ever want to see us, and again I somewhat sarcastically say that perhaps the future science will necessitate progressive and conservative journals. Seriously. Perhaps we need to declare political conflicts of interest. I mean, that's kind of the idea, that if we're going to start going down this road, there's going to be a lot to pay over time. And we just simply from the middle again, have to say to both sides, "Whatever you're saying that becomes destructive to the coming together in a very crucial time where people's lives are on the line, stop it."
Lori Walsh: Let's talk about accountability because one of the things I know I personally struggled with at the beginning of this pandemic, and you mentioned sort of cynical omniscience in this essay that you wrote, was the number of leaders who said, "Who could have seen this coming? We never could have predicted this." And I, on a personal note, Dr. Hoffman, I struggled with that. Because I was like, "How can we even say that we never imagined a pandemic when there's like a bookshelf full of historical stories, and science fiction stories, and movies are made?" And everybody's saying, "This is just like this movie and we had the Ebola outbreak." And of course you could imagine it, but it keeps coming back again and again, with people in charge saying, "Well, no. This specifically is what we could not possibly have prepared for."
Some people are going to hear this conversation and say, "Well, there's just a time when you're right. And it needs to be said that this policy is bad and that's not political. That's just the truth." Or there's a time when you need to hold someone accountable and say, "This administration, whatever administration that might be, or this Congress, or whatever, did not act. And if they had done this, it would have been better." Where do you draw the line between a strong call for accountability and a character assassination, or a bias ripping people down because it's beneficial to the cause that someone else is trying to build up?
Dr. Wendell Hoffman: Yeah. So the example I use, under the cynical omniscience example, is I say, "Should president Barack Obama have heeded the 2015, 'We're not Ready' warning of Bill Gates and his famous TED talk? Or should President Trump have heeded the 2017 'no doubt' warning of Dr. Anthony Fauci?" And my point there is this is not an influenza pandemic. Okay? This is a Coronavirus pandemic. All of the use of pandemic historically has basically referred to the influenza viruses. Had this been an influenza pandemic of course it could have been even worse than what we're facing now. I mean, imagine an H5N1 one pandemic. That one scares me very much, where you've got mortality rates not in the single digits, and maybe even below 1% as we're seeing in this pandemic, but we're seeing in the double digits and maybe into the 30, 40, 50% range.
But my point being is that sort of no one saw coronavirus pandemic coming, I don't believe. Was it potentially under consideration by some who know a lot of about these viruses? Perhaps. So that's part of it. And so I mean, I think any leader by that by definition has to be... We hold our leaders accountable and we do it through the election box. You know, there's basically, what is it? There's two ways in which we persuade. One is through what we're doing here today, is to persuade using reasoned arguments. The other one is at the ballot box where we persuade based upon the casting of our vote.
So at what point do leaders need to be held accountable? I think they need to be continuously held accountable, just like doctors and nurses and the healthcare system are continuously held accountable. When the stakes are high, you don't get to take time off. In healthcare, we don't wait every four years to get voted on. We're voted on with every visit, and so we're used to become accountable for what we do and to step up and say," I was wrong, or we were wrong. We're going to change things."
But the impulse to blame rather than to learn is the troubling feature of I think this situation. So we want to retrospectively blame individual or individuals for something they never could have seen coming. It's kind of like driving a car with only a rear view mirror. "You should have known this at the time. And why didn't you know this?" It happens on both sides. I mean, the most horrendous example I think is the example I use for raw animus where I ask the question, "Is President Donald Trump accountable for approximately 90% of all American COVID deaths?" That came out of the New York Post. Or, "Is Governor Andrew Cuomo accountable for New York's deadly policy of shunting thousands of coronavirus patients from hospitals into nursing homes?"
I mean, this is really where it's become destructive, where we're actually blaming leaders for the death of thousands if not millions of people. That I think we have to stop, or we're not just going to have problems leading up to the election. There are long-term ramifications for accusing each other of that. I don't believe either President Trump or Governor Cuomo can be held accountable in the way in which this criticism is being sort of thrown, because you have to look at what did they know at the time. I mean, if you look at that order that Governor Cuomo issued in late March, he was facing a potential catastrophe. Plus by his own acknowledgement, the data, the models that were being used were wildly wrong.
And so that's just an example. I'm not excusing either President Trump or Governor Cuomo for being responsible. I'm just saying that to look back on this then, and act as though we were somehow omniscient, it gets down into raw animus. In other words, you have to hate somebody a lot, in my opinion, to accuse them of being accountable for the deaths of thousands and millions of patients.
Lori Walsh: It's an article in South Dakota Medicine called The Patient as COVID, the Destructive Bias of Politicized Science. Dr. Wendell Hoffman is the author, and he's been joining us today. Dr. Hoffman, always a pleasure. So much to think about here for how things have unfolded, and how they continue to unfold, and lessons to be learned for the days ahead. So thank you so much for your time today. We appreciate it.
Dr. Wendell Hoffman: Thank you, Lori, very much.